. Motor power may be normal when recumbent, yet patient cannot stand (astasia abasia). 4 Hysterical rigidifly - Rigidly shows variation from moment

atrophies, motor neurone disease. 2. Peripheral nerve - Peripheral neuropathy, Gulllaln-Barre syndrome. 3. Myoneural junction - Myasthenia gravis, familial periodic paralysis. 4. Muscles - Muscular dystrophies, polymyositis INVESTIGATION OF A CASE OF PARAPLEGIA A is the diffculty In walking due to other causes ? 1. Decreased muscle power 2 Disturbances of tone e.g. Parkinsonsm 3. Cerebellar disorder causing ataxia and choreas 4 Loss of postural sense e.g diabetes, tabes dorsalis 5. Hysteria B Is the paraplegia hysterical or organic ? Hysterical paraplegia -1. Plantar response never extensor. 2 No correlation between attribution of sensory loss and known anatomical attribution, or glove and slocking type of anaesthesia Bilateral anaesthesia rare Patient does not bum or cut the anaesthetic skin 3. Motor power may be normal when recumbent, yet patient cannot stand (astasia abasia). 4 Hysterical rigidifly - Rigidly shows variation from moment to moment 5 Reflexes normal or exaggerated. 6. No sphincter disturbances. C. te it upper motor or lower molor neurone paralysis ?' UMN lesion LMN lesion 1 Paresis ol movement 8 Reaction of denegerailon D is the paraplegia due to localised or system disease of the spinal cord ? - In localised disease signs and symptoms are referable to one or two segments of he cord In system diseaae sympiome and signs are referable to various parts of the nervous system Investigation of acase of Spastic paraplegia I History -1 ONSET - [a) Acute - Spinal Acu e transverse myelitits, trauma (fracture dislocation of spine], prolapsed disc. vascular disorders (infarction or haemorrhage), epidural abscess, hystaria Cerebral - Superior saggital sinus Lhrombosis, thrombosis of unpaired anterior cerebral artery (b) Subacule -Developing over two or three days -Acute myelitis, compression of spinal card e g tuberculous spinal osteitis or pyogenic extradural abscess or rarely secondary carcinoma ol spine, (c) Insidious - Menlngomyelife, subacute combined generation, cervical spondylosis, amyotrophic lateral sclerosis, spinal tumour, syringomyelia, multiple scleroste, cauda equlna and conua medullarls lesions and sometimes lathyrlam General paralysis of insane, hereditary spastic paraplegia, and techemic degeneration of spinal cord due to atherosclerosis (d) Unilateral - onset In spinal tumour. 2 AQE - (a) Children - Cerebral dipfegia, hydrocephalus, meningitis, spina bifida, spinal caries and superior longltudinal sinus thrombosb. (b) Adult - Common are spinal tumour, T B spine, transverse myelitis, amyotrophic lateral sclerosis, syringomyelia, murtipie sclerosis and craniovertebrai anomalies (c) Middle and old Cervical apondylosie, subacute combined degeneration, secondary deposits, Pagels diseease. progressive cervical rnyelopathy 3 FAMILY HISTORY-(a) In subacute combined degeneration more than one member of family may have evidence of paraplegia, neuritis or pernicious anaemia (b) In lathyrism more than one member of family affected, and history of consumption of lathyrus pulse (c) Familial incidence in hereditary spastic paraplegia 4 HISTORY OF TRAUMA - Fracture dislocation of spine or haematomyelia 5 HISTORY OF SYPHILIS. 6 RECURRENT PARAPLEGtA - Multiple sclerosis, periods paralyste. recurrent spinal ischemia, A-V malformation with minor bleed or oedema, hysterical 7. SYMPTOMS - (a) Pain - Constant or intermittent in extramedullary spinal tumour, may be aggravated by coughing or straining Root pairs In radlcular spinal syndrome, syringomyelia (b) Numbness and tingling- Subacute combined degeneration, apinal tumours.